We’ve all heard about “use it or lose it”—the idea that if we don’t use skills or habits that the skills will diminish over time. Does this hold true for therapy skills? While it doesn’t take much thinking to realize that we aren’t as good at things that we learned long ago, how soon do we actually start losing these skills?

We actually might be getting worse

Goldberg et al (2016) found that over the course of a 5 year longitudinal study, less than 40% of therapists improved their skills while the remaining 60% of therapists’ skills declined over time. This goes against the conventional wisdom that therapists would improve in their ability to retain clients that would otherwise drop out of therapy, improve clinical outcomes for those who stay, and build overall therapeutic competence. Looking at the quality of the experience and not just at the quantity of experience of the therapists in the study is acknowledged by the authors as a future area of research, it does lead us to question just what is quality?

Deliberate practice (and sooner rather than later)

For anyone who has listened to our podcast, you know our love for Scott Miller and responding to outcome data from sessions. However, there may be evidence that the time between when a therapist learns a skill and when they actually start using it can influence the effectiveness of that skill. Greenwald (2006) estimates that EMDR clinicians who do not begin utilizing the EMDR protocol soon enough after their initial training contributes to a lack of use, a poorer following of the EMDR protocol, and eventually an absence of use of EMDR altogether.

This seemingly has implications for the way that we approach therapist education. Especially for hands on techniques, which should be done as close to the theoretical teachings as possible (let’s not get started on the gaps between supervision training sites and educational programs), but also as relevant to the teachings as possible. What we mean is that some courses of “foundational” knowledge are not experienced in practical settings until much later in one’s career. For example, the practical applications of a Marital and Couple’s Interventions class may not be faced until much later—maybe even after licensure, but having sat through the course allows for a therapist to have met the checkbox of passing the course.

There are some accreditation programs that require these practical applications before a student is allowed to graduate a program, but they do not meet the practical application of all areas of required coursework. For example, a student may never face a client facing substance abuse issues, but is often still required to take a course on substance abuse. These programs would either be forced to create even more hoops for potential graduates to jump through (which we disagree with—we should be making education standards easier, not harder) or to evaluate the necessities of courses as part of the curriculum in the first place.

Regardless of what the requirements are for you, it is up to you to develop and maintain the skills that you learn. We don’t want to see therapists with long ago trainings advertising their skills and practices when they have not kept current with either the updates to the program or regular use in their practice.


Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1-11. http://dx.doi.org/10.1037/cou0000131

Greenwald, R. (2006). The peanut butter and jelly problem: In search of a better EMDR training

model. EMDR Practitioner, 1–14.

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